Many clinical disorders of hearing and language would benefit from collaborative patient-oriented research. This project focuses on auditory neuropathy (AN), a neural type of hearing loss that has only recently been identified and characterized. Its primary characteristics are preservation of otoacoustic emissions, abnormal or absent auditory brainstem responses, and poor speech perception. This multidisciplinary patient-oriented project will develop clinical definitions for AN, survey the potential incidence of AN, undertake a series of seminars on AN, including webcasting, define and support pilot projects, identify resources needs for full- scale patient-oriented research on AN, and prepare one or more endpoint grant applications. A group with wide expertise has been assembled with interest in AN. As a whole, the project will be a model for developing collaborative, multidisciplinary patient-oriented research. JUSTIFICATION FOR THIS R24. The clinicians and researchers who are partners in this project need this mechanism in order to develop a common language, goals, and a focused research program. RELEVANCE TO PUBLIC HEALTH. Although a newly identified disorder, we suspect that auditory neuropathy is fairly common yet rarely diagnosed: Patients with good peripheral responses who complain of difficulty with speech communication occur with great frequency, as are patients who are unable to benefit from hearing aids. These individuals are seen throughout the age range. They experience significant handicap in their lives and their vocations. Their communication handicaps have negative implications for their emotional health and well-being. If AN is an appropriate diagnosis for these individuals, they represent a sizeable proportion of the audiological and otological patient population. The potential to deliver more effective health care to these patients is significant. This project also will have an impact in the area of improving scientist-physician interactions for developing and carrying out research. Important opportunities are lost when the clinical and research enterprises become too distinct from each other, and we will undertake to develop mechanisms that promote full partnership between the lab and the clinic. [unreadable] [unreadable] [unreadable]